Re: FluTrackers Interviews WHO Representative Gregory H?rtl
Re: FluTrackers Interviews WHO Representative Gregory H?rtl
1. Questions around concerns regarding a third wave, particularly in countries with a low uptake in the vaccine (e.g. Italy purportedly).
a. U.S/Canada examples: There has been a noticable leveling of ILI in the U.S., however, increases in ILI are being seen in emergency rooms in regions over a period of weeks then seeming declines.
http://www.isdsdistribute.org/
It is estimated that 25% (approximate) of the U.S. has been vaccinated with another 20% plus having been infected.
In Ontario, it is estimated that 40% have been vaccinated with a corresponding number of infected individuals.
http://www.cbc.ca/health/story/2010/02/10/ontario-h1n1.html
Q: Has herd immunity been achieved at levels that would either suppress or mitigate a third wave (assuming existing virus stability and vaccines)? And do countries with a low uptake of the vaccine represent situations where the likliehood is increased of a third wave?
2. Dr. Niman with Recombinics appears to have some serious concerns about information and how it has been presented and released by WHO and other governmental entities. Do you feel that WHO is being transparent in it's presentation of information regarding possible mutations and the potential ramifications? It is alleged that at least the appearance of a lack of transparency is being perceived.
Q: Do you think WHO could improve how it communicates with the citizens of the world. Is the concept of transparency explicit in your communications plans?
a. What is the WHO doing to address the need to incorporate "severity" into its response models? The recent attacks by quasi governmental entities in Europe claiming a "false pandemic" seem in many respects to be a result of not being able to effectively communicate "why" the world responded in the way that it did. Many articles have noted this. It has also been noted how effective CDC's Dr. Besser was in communicating the initial phase of the pandemic including addressing severity issues as foundational in its planning in April and May of 2009. The media quickly used the CDC severity index to explain what the U.S. was doing and the PSI explained "WHY." A recent Harvard Poll has noted a positive response by the public in the United States to the U.S. public health response. "A majority of adults (59%) rated the overall response of public health officials to the H1N1 outbreak as “excellent” or “good.” Conversely, 39% rated the overall response as “fair” or “poor.” In the view of more than half of adults (54%), public health officials spent “the right amount” of attention on the H1N1 flu outbreak, but 26% said they spent “too much” attention, and 16% said they spent “too little.”
http://www.hsph.harvard.edu/news/pr...-of-americans-believe-h1n1-outbreak-over.html
Many have noted that NOT addressing the severity element in an "effective" fashion similar to the CDC's pandemic severity index (PSI) may have harmed the messages WHO delivered and set the stage for the criticisms that have followed.
WHO did address the severity issue in May
http://www.who.int/csr/disease/swineflu/assess/disease_swineflu_assess_20090511/en/index.html but it's response seemed to be more confusing than explanatory.
Q: Would a more simple easily communicable approach like the CDC PSI incorporating some of the elements noted by WHO in the May communique have better served WHO and the world...in retrospect? And what is planned for the future?
(aside: It is noted that a defacto PSI was able to be discerned within two weeks of the initial outbreak and in fact news media were even able to do it. The nature of a pandemic is such that it is much better, perhaps essential, to "over react" at first with a novel agent and then like a rheostat, dial down the PSI as more data comes in. Intrinsically and dynamically, when a novel biological agent is introduced, very likely, the first indicator will be "case fatalities." Thus like an iceberg where you only see the tip, you can make some decent guesses on the size of the iceberg underneath by a quick look at ILI even in resource poor countries it will be notable. WHO noted that the dependence upon a "case fatality ratio" was a core weakness of the PSI. In retrospect, it appears it was enough to provide a skeleton of a response based upon an easily understood and communicated set of "pre-planned" "triggers (PSI) that all understood even if not complete or all encompassing. As a novel agent spreads, it will then provide a depth and breadth of information that will allow public health to "flesh out" the skeleton and dial back or up the PSI as circumstances warrant. (Starting from scratch and not doing it very well or perhaps even clearly is still reverberating.)
